Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent neurobiological disorders that inhibit children. 6.4 million American children, aged 4 to 17, have been diagnosed with ADHD. 6.1 percent of these children are being treated with medicine.
ADHD is a condition that makes it harder to pay attention, causes hyperactivity and leads to impulsive behaviors. It is often diagnosed in early childhood, typically at the age of 7.
ADHD has the ability to influence a child’s thinking, academic performance, behavioral patterns, feelings, and relationships. It often continues into adulthood.
Treatment of ADHD in children includes a combination of medical, educational, behavioral and psychological interventions. Such an all-encompassing, comprehensive approach consists of educating the parent and the child about diagnosis and treatment, behavior management, medication, child and/or family counseling, and enlisting school programs and supports.
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There is no one size that fits all. Treatment needs to be customized as per the individual needs of each child and family.
The Role of Medication in ADHD
When it comes to treatment for most children with ADHD, medication, only prescribed by medical professionals, forms an integral component. It is important to understand that medication is not used to control behavior or cure ADHD. Instead, it is used to ease out the symptoms of ADHD during the time it is active.
Since each family and case is different, the pros and cons of choosing medication as part of the treatment plan for ADHD must be weighed in. Research has demonstrated that children and adults who took medication for symptoms of ADHD, most often credited their successes to themselves and not to the medication.
ADHD and Stimulants
Psychostimulant compounds are the most widely used medications for the management of ADHD symptoms. They assist vital networks of nerve cells in the brain to communicate more effectively with each other. 70 to 80 percent of children with ADHD respond positively to these medications. [2]
Stimulants are generally started at a low dose on the weekend so that parents can observe the child closely. The dose and timing of the medication can be adjusted as per the individual needs of each patient.
A medication trial is recommended where an initial low dose is gradually increased at an interval of 3 to 7 days until clinical benefits are optimized. Several increases in the dosage are common during the trial.
Typically, only one stimulant is used at a time.
Furthermore, parents need to understand the need for close monitoring during treatment. If the child needs to take medicine at school, a school nurse or faculty member should be responsible for keeping this medicine and give it to the child at the appropriate time. This helps avoid misuse and loss of medication.
Methylphenidate and amphetamines are the most commonly used stimulants for the treatment of ADHD.
Non-stimulant Medication
Non-stimulants may be used as alternatives when psychostimulant medications have rendered ineffective results, significant side effects or any other reason due to which the individual or child’s parents prefer a non-stimulant.
Antidepressants that actively influence the neurotransmitters norepinephrine and dopamine have also been found effective in treating symptoms of ADHD.
Recommendations
The American Academy of Child and Adolescent Psychiatry (AACAP), in collaboration with the American Psychiatric Association (APA), published a medicine guide that provides recommendations based on the best available medical evidence for the diagnosis and treatment of children with ADHD. The guideline is intended for healthcare providers.
Recommendations for treatment of children and youth with ADHD differs on the basis of the patient’s age:
- For preschool-aged children, aged 4 to 5 years of age, parent- and/or teacher administered behavior therapy is recommended as the primary treatment. The healthcare provider may further prescribe methylphenidate to treat ADHD if the child continues to experience symptoms. [3]
In case of evidence-based behavioral therapy not being available or accessible, the clinician needs to determine the risks between an initiation of medication at an early age and delayed diagnosis and treatment.- For elementary school–aged children, aged 6 to 11 years, approved medications for ADHD and/or evidence-based parent and/or teacher-administered behavior therapy as treatment for ADHD is preferred. It is highly recommended that treatment should include both medication and behavior therapy simultaneously. [3]
- There is particularly strong evidential support for stimulant medications and in a descending order, lesser for atomoxetine, extended-release guanfacine, and extended-release clonidine.
- The environment, programs and placements at the school form a vital part of any treatment plan. These may include school programs that offer particular seating, amended work assignments and test modifications regarding location or duration alongside evidence-based behavioral therapy or special education.
- For adolescents, aged 12 to 18 years, FDA–approved medications for ADHD in accordance with the adolescent’s consent and behavior therapy are recommended as treatment. Both components are preferred be used in unison. [3]
- It is necessary for the primary care clinician to closely monitor and alter the doses of medication, as required, in order to attain optimum benefit.
The Bigger Picture
Primary care clinicians alone can only go so far in the treatment of school-aged children with ADHD. It is necessary to maintain communication with parents, teachers and other school-based professionals to effectively monitor the progress of specific interventions.
Parents are the main sources of information on a child’s treatment as their primary caregivers. Integrating these interventions with services from psychologists, child psychiatrists, educational specialists, developmental-behavioral pediatricians, and other mental health professionals may be particularly helpful for children with coexisting conditions and persistent symptoms.
What needs to be prioritized is the child’s social development and integration in not just a school setting but in the society and community as well.
About the Author:
A journalist and social media savvy content writer with wide research, print and on-air interview skills, Sana Ahmed has previously worked as staff writer for a renowned rehabilitation institute focusing on mental health and addiction recovery, a content writer for a marketing agency, an editor for a business magazine and been an on-air news broadcaster.
Sana graduated with a Bachelors in Economics and Management from London School of Economics and began a career of research and writing right after. The art of using words to educate, stir emotions, create change and provoke action is at the core of her career, as she strives to develop content and deliver news that matters.
References:
[1]: https://www.uptodate.com/contents/treatment-of-attention-deficit-hyperactivity-disorder-in-children-beyond-the-basics
[2]: http://www.chadd.org/understanding-adhd/for-parents-caregivers/treatment-overview/managing-medication.aspx
[3]: https://www.cdc.gov/ncbddd/adhd/guidelines.html
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Published on May 14, 2017.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on May 7, 2017
Published on AddictionHope.com